MEDICARE: PHILADELPHIA SCHOOL OF PSYCHOANALYSIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist
2	103TH0004X	Health Psychologist
3	104100000X	Social Worker
4	101YP2500X	Professional Counselor
5	1041C0700X	Clinical Social Worker
6	103TC0700X	Clinical Psychologist
7	103TC1900X	Counseling Psychologist
8	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	122030	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922162130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA SCHOOL OF PSYCHOANALYSIS

Provider Business Mailing Address
First Line	:	401 S 2ND ST STE 303
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1612
Country	:	US
Telephone Number	:	215-732-8244
Fax Number	:	215-732-8454

Provider Business Practice Location Address
First Line	:	401 S 2ND ST STE 301
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1612
Country	:	US
Telephone Number	:	215-732-8244
Fax Number	:	215-732-8454

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. LISA CORREALE
Credential	:	LCSW, NCPSYA
Telephone Number	:	215-732-8244

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	05/19/2026

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Directions to “PHILADELPHIA SCHOOL OF PSYCHOANALYSIS ” Practice Location

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